b'SPORTS MEDICINEleft foreleg. Shed shown earlier that day and had pulled a few rails in the class, something that was out of character for the careful jumper. Because the swelling, pain, and heat was obvious, we didnt do any nerve-blocking, Schlachter recalls. We just ultrasounded her leg and found a signifi-FRANK SORGE/ARND.NLcant core lesion in her left front distal check ligament (which originates at the back of the knee and attaches to the deep digital flexor tendon).Back at Izzys farm, Schlachter per-formed shock wave therapy and injectedA horses rehabilitative workload might include a variety of exercises, including walking and trotting over ground poles.autologous protein solution into the ligament, then placed her in a controlledconcreting and pulling the tissues togeth- day, place their thumbs on the injury site, exercise program. After two months ofer. So, we did a second round of shockand rub across the fibers of the ligament hand-walking, Izzys foreleg was still puffywave on the ligament, and we startedfor 60 seconds. She often recommends and painful. As a precaution, Schlachterimplementing a routine of cross-fibercross-fiber massage for check ligament decided to re-ultrasound her and discov- massage, which involves using smallinjury patients. ered an adhesion forming between theback-and-forth strokes to help break upI see four or five cases per year of check ligament and the superficial digitaltissue adhesions and increase flexibilitycheck ligament re-injury, and its always flexor tendon (which lies over the DDFT).during healing.an adhesion in that area, she says.There was a lot of swelling, whichThe prescribed massage routine wasFrequent diagnostic imaging can also shows inflammation, she says. As thatconcise. Schlachter instructed Izzyshelp ensure these are not forming at the inflammation started to go down, it wasowner and trainer to pick the leg up everyinjury site. I like to ultrasound every 30 days during recovery when theres risk for an adhesion, so I can keep an eye on the area, Schlachter says. For normal, more superficial injuries, I try to ultrasound every 45 to 60 days during recovery. When Izzy reached 10 minutes of trot-ting under saddle during her controlled exercise routine, she started getting sore again. At that point, we looked at the rest of her body, says Schlachter. We found out that she was very sore in her hind end, likely from standing around. The result was that she ended up with inflam-mation in her hocks. We injected her hocks, dropped her back down to walking for two weeks, and then started back into the trot program, and she was fine.Ten months post-injury Izzy had recov-ered and returned to training, eventually competing in the 1.30-meter jumpers. Take-Home MessageBeing tuned into your horses physi-cal and mental well-being can be key in preventing a career-ending injury. Learn to run your hands down your horses legs every day so you know whats normal and whats not normal, Schlachter says. And respect your horse. If they undergo a per-sonality change or your relationship with them is suffering, theres usually a reason why, and its usually a physical one.h32August 2020The Horse|TheHorse.com'